Anesthesia Emergency: Malignant Hyperthermia

Anesthesia has been described as hours of boredom punctuated by moments of terror. In this video, I discuss a rare condition called malignant hyperthermia and how it can result in an emergency in the operating room.
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0:00 Start
0:31 Introduction
1:16 Frequency
2:49 Pathophysiology
4:25 Preparing for MH patients
5:58 Intraop diagnosis
8:08 Treatment
12:35 Out-of-OR diagnosis
Thanks to Francine S. Yudkowitz MD, board certified pediatric anesthesiologist, for reviewing this video prior to posting.
Music:
Subtle Swagger by Ron Gelinas: / atmospheric-music-portal
The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional.
#Anesthesiology #Residency #MedicalSchool

[@saywhat5187]

Doctors seem to love the expression, "when you hear hoofbeats, think horses not zebras." MH is definitely a zebra. So the hat is a nice touch.

[@paulsdrc]

My wife is susceptible to this, we informed her anesthesiologist before a surgery and he said he “did his homework” and produced two large binders of notes. He just said all these notes add up to no gas. He was awesome surgery went perfect.

[@bj_cat103]

is there a way to find out If you are susceptible?

[@paulsdrc]

@@bj_cat103 My wife found out the hard way…

[@carolynapappas]

@@bj_cat103 If you've had a previous episode or if you have a family history. He mentioned in the video that there is a blood test for genetic markers but it's not fully accurate.

[@FatherDuck80]

You’re lucky cause at Cleveland they almost killed my spouse and refused to listen to her. She Has this Malignant hyperthermia and they still insisted on putting her under general anesthesia on a stupid simple out patient procedure that could be done with a local or and epidural. Suing the F-ck out of them. Horrible care and horrible hospital . I got her out of there and took her to Mayo Clinic. People. Vett these anesthesiologist and surgeons. The pre-op nurse at Cleveland was ther only one who fought for her safety and request for local anesthesia. My hat goes off to her. 🙏

[@imkriswithak1135]

@@bj_cat103 family history and muscle biopsy

[@rm-dc6tx]

FANTASTIC explanation. With a family history of MH, presenting in an emergent situation at a major Boston Hospital, I was able to get the Anesthesiologists attention and tell him I had a family history. Literally, everyone stopped talking and the anesthesiologist leaned over me and thanked me for telling him and reassuring me that he understood and then instructed the CRNA to turn off the gas and add a charcoal filter, then I was out, and had no problems with my surgery. I later asked to see him and thanked him. In a brief discussion he thanked me again as it enabled him to ensure a safer operating environment. he added we like to avoid emergencies if at all possible, so always speak up with any anesthesiologist. This was a fantastic review. Well done. Thanks

[@thewholeroll]

This sort of thing really shows exactly why anesthesiologists are MDs with a high level of specialist training. Plus, also why it's important to have a doctor whose sole role it is and is present & monitoring throughout the whole process

[@janetguevara5420]

I had an episode of Malignant Hyperthermia during a surgery to remove my kidney. I had many surgeries under normal general anesthesia without an episode. During my surgery they had just began to operate when the anesthesiologist notice my temperature spike, he then noticed the muscle rigidity in my jaw and arms. He stopped the surgery and called the MH Hotline. Luckily they had Dantrolene. They used the cooled IV Bags to cool me down. When I finally came around I was in ICU and still had my kidney. I was so upset when they told me what happened! I need to get a medic alert band saying that I have MH. Thank you for covering this topic!

[@BuickDoc]

During my second month of Anesthesia training I did my first anesthetic for a child. I guess they figured it would be an easy case since the child was 4 years old, about as technically easy as it gets. Think in terms of scale: it would be easier to cut a cat's nails (claws, asleep) than those of an elephant or say, a mouse. There is a certain range of size that is easier for humans to work on. And for anesthesia, that optimum size is about 4-5 years of age. The child had a cancer of the eye, a retinoblastoma, requireing removal of the eyeball. About 2 hours into the case (the new Ophthalmology Residents were doing the case. The fully trained ones could have done it in 30 min.), I noticed that the child was breathing despite being on a ventillator at a setting that had been adequate previously to remove her CO2 production.. The child progressed to an obvious case of MH which I successfully treated with dantrolene, which was only available in oral form then. I had to grind up the capsules and flush them down a Naso-gastric tube, but she survived. She returned four more times for examination of the other eye under anesthesia. I did her anesthetic every time. As a matter of fact, I did the anesthesia for almost all suspected or known MH cases for the rest of my Residency. I became the Great Guru of MH...Lol

[@ShoreShihTzuNurs]

What year was that? As a veteran OR nurse, I only recall Dantrolene in IV form.

[@BuickDoc]

@@ShoreShihTzuNurs Probably Aug, 1978. I think the IV formulation came out in 1979. A lot of hospitals refused to buy it at first because of the cost, so it was at least 1980 before all the hospitals I worked at stocked it.

[@ShoreShihTzuNurs]

Interesting. I’ve ‘only’ been a RN since 1980, 42 years. That’s why I don’t recall po Dantrolene. Thanks!

[@fxrvw7052]

Thank you for sharing. Very Interesting!

[@ThesmartestTem]

I had my MH event at the age of 2 in 1988. Also during an eye surgery. The only reason I lived was because the anesthesiologist had seen it one other time before and knew what to do.

[@cames1132]

Retired OR nurse here. Mandatory yearly written testing and practicals for MH. As many moving parts for MH crisis, assignment cards were handed out so as to avoid confusion. It was also important to know where the closest ice machine was so that along with cold IV solutions and lavages,ice packs could be made for cooling of the patient

[@catmom1322]

Ditto. Our OR had a MH crash cart, complete with dantrolene.

[@loriet2349]

Veterinary tech here, I could listen to you talk all day. Great methodical teaching.

[@Sunflowerxbabe]

Thank you for making this video! It can be a bit of a challenge explaining what happens. I lost my maternal grandmother due to an MH event. She was 32 at the time, sometime around 1972-73. My mom, sister, and I all wear medical bracelets and discuss it with every anesthetist we have.

[@kurtcrean]

It runs in my family and my brother and I both tested for it and are susceptible. I got a tattoo for it and every anesthetist has been overjoyed and when I go to that hospital they know me as "the guy with the MH tattoo" haha!

[@jpmasters-aus]

What a great idea - I would love to see the tattoo and where you had it place.

[@ianwilliams4480]

With strong family history of MH I have considered a tattoo. In all seriousnes, where did you choose one have it put?

[@kurtcrean]

@@ianwilliams4480 I have it on my left forearm, my brother is a paramedic and said it's a good spot, something as simple as the letters MH would be enough but mine is a medical alert symbol along with the words "Medical Alert Malignant Hyperthermia" It's more for my peace of mind than anything, it's unmistakable.

[@benbookworm]

I’m a pharmacy technician that’s recently moved to the inpatient side, and one of my favorite shifts is restocking the operating rooms. I’ve really enjoyed your videos, getting to see why certain medications are used and what the stuff on the walls is talking about.

[@nakomanix6752]

Thank you for posting this. I’m from the UK and its the first time Ive ever seen a video about malignant hyperthermia. My uncle went into an operation for back surgery and after the surgery had finished he had his attack. At the time not many doctors knew about this and unfortunately he passed away. Since then my whole family have had the muscle biopsy test and my mum and grandad both had the gene. This post randomly came up in my feed and honestly it means alot to see it explained in more detail and to know that its getting taught to others who can hopefully save lives. Thank you 😊

[@marykirschman6625]

0:37 great video!!! My brother died of MH six years ago. By the time he was diagnosed, it was too late. His symptoms started a couple days after his surgery. Now I can let the anesthesiologist know if I ever have surgery so they can be aware of the family history.

[@harvesthawk5772]

I possibly had a bout with MH during a 1991 surgery. Afterwards, at that time, I had to go to the county library to learn about it because there was no internet yet. When I queried the doctor via a written letter about it several weeks after my surgery he ignored me. To this day if I have surgery I tell the anesthesiologist what happened in 1991 and that I may be susceptible to MH. So far so good.

[@zook357]

Had a Motorcycle accident in 1980, aged 18, and broke my Femur. Ambulance could have taken me to 2 hospitals. I had an episode whilst under, but fortunately the hospital I was taken to was our major teaching one, and had stock of Dantrolene. I also spent 3 days in ICU. A year later, had a CHCT that was inconclusive, so had a second CHCT test, confirmed I was MH Positive. 2 large scars from the biopsies, and memories of 12 weeks in traction confined to a bed.

[@rnryder4890]

Way back in 1982 my baby brother had a MH event during reconstruction surgery of his ear. Both my parents were sent to Toronto General Hospital for Biopsy of their thigh muscles. Results indicated that both my mother and father were carriers of the gene. My brother was 5 Years old when that happened and he required alot of therapy afterwards. Thankfully he came full circle.

[@xelakir5452]

I've been shadowing surgeons for the past few months as I've been applying to medical school and I noticed a poster in some of the ORs displaying information about malignant hyperthermia. I knew a little about it from the brief Google searches I did, but this video is amazingly thorough with interesting information and statistics, so thank you!

[@jxh02]

I saw such a poster in the office of my dental/oral surgeon, had an idle moment and looked at it. I remember two things: (1) Get help, (2) Get dantrolene. And then the rest. I'm glad they're up to date on this.

[@SD45-ET44AC]

One of the best MH lecture/ inservice I’ve ever seen of the 24+ years working in PACU & OR!

[@lisatague305]

As a young RN years ago in a 10 yr span I saw 2 cases . One occurred intra op and one in the PACU . Excellent video !

[@MikeIsCannonFodder]

Removing the vaporizer made me think of Ghostbusters for some reason: when they stick the traps in the containment unit to empty them and pull them back out.

[@marystewart1746]

I watched your costing video, and then compared it to the last pharmaceutical cost for my surgery. It was comparably close. This gave me much more confidence that I'm not being "over-billed". Thank you!! I've learned a lot, for a patient, by watching your videos!!

[@DavidGrub]

I am not in the medical field, but have had my share of surgeries including open heart when I was 7...46 years ago. I find your videos informative and fascinating.

[@robert19]

Amazing video Dr. Feinstein. I just got back from a month long trip, to find a video of yours was posted yesterday. Your videos are amazing and always super interesting, and you have inspired me to pursue medicine. I hope you keep making videos and your channel keeps on growing because you are crazy underrated. 10/10 content.

[@Kermittreefrog]

Wow! This video was randomly suggested to me which is great! I was diagnosed with malignant hyperthermia at the age of 2 when I had my appendix out. I almost died. I had no idea this condition may be what lead to me losing my left kidney which I found out 9 years ago does not function and doctors say it has probably been that way my whole life. But my reaction at age 2 seems like it may be the culprit. I do know that any time I have surgery, I have to let the surgeons know immediately and I am very closely monitored. This is a great informative video. Thank you for helping me understand something about myself more then I have ever before.

[@starfishgurl1984]

This was very informative, thanks for the info! I had never heard of this but it’s nice to know you’re prepared for things like this just in case because you never know what could happen and helping others be aware and prepared could prevent a potential disaster so great job as always on another fantastic video 🙂.

[@phyllojoe5346]

Love your videos! Your explanations are so in depth

[@DanielSRosehill]

Fascinating! Thanks, Max, and best of luck with your ongoing residency. Your patients will be lucky to have you.

[@lisabeierling1837]

I really appreciate this detailed explanation. I am a care coordinator for a child with a family history of this. I have it detailed in her records but really had no understanding until now.

[@musman9853]

I've been waiting for this one!!!

[@osamazaid7992]

Today I had a horrible day.. really wanted to refresh on how to manage anesthesia emergencies and then you upload this video 2 minutes ago 👍👍

[@doristhecoder765]

Another great video Dr. Max!

[@SolarAB]

Thank you, brother. Love these bite-sized knowledge nuggets. And you are very good at them.

[@michelleking9542]

I’m a nurse in Florida. So glad I found your channel! Your videos and the way you teach tells me how awesome you treat your patients. I miss being a scrub nurse. We were all like family. I have the utmost respect for you. Keep up the amazing videos 💕

[@keily33]

Love your content, Doc! You are a great doctor, hope I will be like you one day 😊

[@GoldenBladedPhoenix]

Thanks for being awesome Mr. Feinstein

[@mariecarlton5768]

This one of the best info/educational video I’ve ever seen. Thanks for helping patients

[@curtiswritt8474]

always love your videos Doc

[@kimberlyfadim1703]

Love your videos Dr. Feinstein!!!

[@mariecarlton5768]

This was absolutely the best educational video! Thank you. Nothing matches patient awareness.

[@lulumoon6942]

You are a great science communicator, thank you for fitting us in, Doc! 👍❤️😎

[@timakhabibullayev7906]

Wow!!!Amazing! Thank you for explanation! Don`t stop making good videos!

[@SJR_Media_Group]

Never heard of it until now... thank you for an informative video.

[@laviniafratila2677]

As usual, perfect informative video!

[@MohammedIbrahim-uc2nf]

Thank you very much for the video with kindness and respect

[@ramooyeido1772]

May God reward you for the good useful info you teach.

[@denniscrumbley8274]

Very informative! Thank you. I had 2 MH episodes in the early 1980's and no one explained why I had severe contractions, once falling on the floor and the 2nd I would have but they caught me in time and saved my life. I discovered I have MH b/c I was sharing these experiences w/ a nurse who knew what happened and she told me. It has since been confirmed that I have MH. I now where a medical alert chain around my neck.

[@shainanembhard]

You are an amazing teacher I watch your videos all the time. Thank you!!!

[@sherrydawson6253]

Wow this was so interesting. It amazes me how much u guys have to know! Alot of people think u just quickly spike a high temp. So fascinating 👏 thank you! Oh have u ever encountered a case your self?

[@intheshell35ify]

I've often wondered why I have to meet with the "gas tech" before surgery. Yeah, no, apparently that person is a "gas doctor" responsible for keeping me alive while the surgeon plays with his knives. Had no idea. I'm getting another cervical fusion next Friday and after watching these Dr Max youTubes I'll actually be able to have an intelligent conversation about post op pain and nausea.

[@englishruraldoggynerd]

Good luck with your operation, I hope you get the results your looking for 👍🏻

[@ManmeetSingh-wg3te]

Enlightening ; love your videos.

[@Robby334]

I love watching Max its very interesting Thanks for your channel your knowledge as an anesthesiologist is fantastic

[@johnchristian9162]

Excellent summary, sir. Thank you. Just forwarded to ER nurses, PACU nurses, house supervisors, CRNAs at our very rural facility.

[@lilika6620]

Thank you so much for always putting out great anesthesia content! I'm impressed by how much detail you managed to fit into a 14-minute video while keeping it easily digestible.

[@nadiasingh9814]

Love your videos Doctor

[@LillySternz]

Great explanation! Thank you for this video.

[@sheetalchauhan233]

Such a good explanation of MH. Thank you so much 😊

[@fadeskywards1245]

Very informative. Thanks!

[@beatricewiah5689]

That was so concise, thanks

[@bluejedi723]

Thank you, you explained this better to me in 15 minutes than my instructors could do in 10 weeks

[@tanzanitet8940]

Love watching all your videos 😁

[@Anonymous-sn4gn]

Incredible video, thank you so much

[@michaelmcgrail6522]

Excellent, I run the simulation lab at OU College of Medicine and your view of the MH cart was exactly what I needed. Doing MOCA this weekend and it needs to look right. Thank you!

[@smokeytwitchsmokey]

Best way to start the day

[@blueraiders2295]

Great video Dr. Feinstein!! Could you do a video rundown of the most common surgical emergencies you’ve come across and how they are treated?

[@tanzanitet8940]

Yes please do - that would be amazing to watch and listen to 😁

[@hppower7410]

Wow, your knowledge is extensive, and sharing may help save someone one day in the surgery suite. If i need a procedure in the future, I would want YOU in the suite administering and monitoring me as the carpenters cut and screw. Great Videos. HP

[@marcochiarini3168]

Super greate video! Thank you very much!

[@livelife2324]

Doctor, can you do a video about the different subspecialties within anesthesiology and the job outlook and lifestyle for each? Thank you! And this is a great video as usual.

[@kaylacounihan5904]

Very informative. My sons father is MH+ with an event as a toddler during a hand surgery. My son is MH susceptible and when he needed his tonsils and adenoids out, the anesthesiologist was very reassuring and knowledgeable. And we were first of the day! Easy in and easy out :)

[@shadowmystery5613]

Haha great Video Dr. Feinstein 👍 Reminds me of ages long time past when I worked in the surgical tract for 1 day to see if I am able to cope with what I'll be seeing there before embarking on my 9 months civil service. Still up to this day I can remember that poster on the glass door about malignant hyperthermia and how it's treated 😄

[@p33kin89]

HOW does this video only have 425 likes. Great information

[@LaurenE1991]

I had the IVCT done in 2004. Blood tests weren't done then but they took my blood to help research so further down the line nobody would need the biopsy done. I'm in the UK so it's different there is only 1 test centre. I came back negative. But I always warn people I have a massive family history of it they would rather be safe than sorry. They also test for central core disease when doing it here as it's connected to MH. My aunt died aged 14 during a routine surgery in the 70's she saved so many lives though otherwise we wouldn't have known about it. Very informative video

[@wilcharl]

Max - your quote about hours of boredom followed by moments of terror isn't the only parallel anesthesia has to aviation - would be a cool comparison video - time of useful consciousness, hypoxia, and other aeromedical factors, not to mention - protocols, and human factors engineering - same fonts and colors on aviation instrument displays as anesthesia machines, similar aural warnings - human factor engineering - Fun fact : at 40,000 feet your time of useful consciousness is under 20 seconds - that is why you place the O2 mask over yourself before assisting others - pilots have diluter demand masks because at 40,000 feet, there isn't enough pressure in the atmosphere to allow your lungs to absorb safe levels of oxygen, even if you're breathing 100% O2

[@MaxFeinsteinMD]

I have been trying for months to find a pilot who will let me ride along with them and have a discussion about aviation and anesthesia. One of these days, hopefully!

[@GeneralAviationGuru]

@@MaxFeinsteinMD I’d have you fly with me anytime!

[@tanya5322]

@@MaxFeinsteinMD the family practice MD who delivered my second child once confided in me that he had recently bought a plane, I don’t imagine he is the only MD with a pilots license. Also, I know that in addition to helicopters for medical transportation, some hospitals (Mayo Clinic) have a small jet for transporting patients greater distances, those pilots would presumably have experience flying at an altitude where loss of cabin pressure could be a problem. Or, if you have much for spare time, there are some pilots with KZbin channels. I am bit a pilot (or a doctor), but i have found the channel Mentour Pilot to be quite educational and informative and Petter seems to enjoy learning about science as well. Kelsey from 74 Gear is probably closer to you in age and is a fun channel to watch… he may or may not be the best option for a collaboration, but there are a good number of pilots in the comments section of his videos that you might just get lucky. Also, Dr Rohin Francis of the channel Medlife Crisis could be an interesting collaboration.

[@DavidMacchiaW]

Very informative.BTW, cool scull cap.

[@jpmasters-aus]

Excellent video. I am the 1st person in Australia to survive an MHA attack (18yo). I have the subsequent leg scare from being tested by Professor Denborough in Canberra, one of the early researchers in this field (many anaesthetists in the 1970s loudly rejected his hypothesis). We were the 13th family in Australia to be confirmed, and my Father was subsequently tested as the genetic carrier. I come from a line of single children (or where there was more than one, usually one child died before their 20s). I have been in a blood research trial for over 20 years, and no results have come through. I now have two kids (now in their 20s), and we haven’t done the invasive test, and the child that has had operations, they take the approach that he has MHA. I have had many operations, both as a kid and an adult. As a kid, it was considered likely Halothane ws used at one time but didn’t trigger, which is interesting. I have had procedures delayed for several reasons; in the 1990s because the major hospital didn’t have the recovery drug available, and they borrowed it from another hospital to have ready. On another occasion, I was in a hospital, and there was a theoretical complication, so they wanted to do a test (colonoscopy/endoscopy), but the anesthetist forgot about the MHA. I was placed at the end of the list, so it got cancelled, and I then had it the next day. That meant I wasn’t able to eat for 72 hours! Things have definitely improved; when my father had his triple heart bypass, they had two operating teams and performed it in 90 mins as there was in the 1990s a theoretical max surgery time of 3 hours. In 2020 - 2021 I had many surgeries that lasted around 5 hours, which, when the first one was only scheduled for 50 mins, freaked me out when I woke up. The other matter to consider is the patients' anxiety. Whilst I have a very good understanding as a patient (as an example, unknowingly to me, I was part of the exam for a registrar for an operation involving my son, and the leading anesthetist used my son’s procedure to bring all the registrars in for a refresher knowing they had a case coming in, and after the pre-op questions by the registrar (which I don’t usually deal with) the leader anesthetists asked me about his approach, I replayed the questions, my views on his approach and he “passed”! But because I still clearly remember the episode, even now over 40 years ago, and my knowledge, I can still have anxiety. I decided once to have a partial colonoscopy without any anaesthetics (I probably won’t do that again). In 2020/21, with all the operations I was having, at one stage, my anxiety increased. So the anesthetist who was involved in all of them suggested I come in the night before (for what was a planned day surgery), settled me in and provided some anxiety medication to help. Another unintended consequence was my accident in 2020. I fell walking, and it took the ambulances a couple of hours to recover me. When I was at the major tertiary hospital, they attempted to relocate my shoulder in their procedure room in ER but could not. This meant they needed to bring an ortho surgeon in, and another anaesthetic was required, but in an operating room. It took time to find a theatre and clean it, so I went into the theatre about 9-10 hours after the accident. Apparently, shoulders don’t like being dislocated for an extended period of time, and it ultimately caused auxilary nerve damage. Unfortunately, I have lost the photos of my cells taken from Prof Denborough’s leg biopsy; he commented that my muscle cells were considerably larger than usual, which he had seen other patients. Finally, when I had an attempt to desensitise myself to Penicillin (which didn’t happen and I spend two nights in ICU due to multiple anaphylactic episodes), I was interested in your video’s commentary on potassium for the heart and also insulin. During those anaphylactic episodes immediately, my potassium levels dropped to dangerous levels, and on the second morning, I needed insulin. I assume that the high-end reaction to such anaphylactic episodes is unrelated to MHA.

[@scrumptious9673]

Loved that you shared this, thanks 🙏

[@Golgi-Gyges]

Very professional!

[@ramooyeido1772]

Thank you doctor

[@darriontunstall3708]

Great video man! I learned a lot, that was very great info! Thanks! You rock man! I enjoy donating to the anesthesiologist Foundation since It was hard for me to go to college to be a anesthesiologist after I graduated high school in 08 because of my cerebral palsy

[@muntacamil1463]

Dr. Max........You are always there for us. Thanks 🙏🏻. Family History is key in patient evaluation

[@johnmichaelrichards]

Excellent video tutorial on MH. I have only once dealt with a case of Malignant Hyperpyrexia (Hyperthermia), in the UK in 1992. It was a 19 year old male undergoing removal of impacted teeth. They received induction with propofol, intubation with suxamethonium and maintenance with isoflurane. Spontaneous respiration on low-flow circle. All fine until around twenty minutes in when breathing became laboured and SpO2 dropped. EtCO2 was normal. The surgical procedure was halted and isoflurance ceased. Sadly, despite bolus and infusion of Dantrolene and quickly putting the patient on cardio-pulmonary bypass with cooling, the patient died. The had been no prior familial incidence of MH.

[@XxAkefiaxX]

i have this! i believe i was diagnosed with it when i was 3 months old in 1992 (i was born with dislocated hips and this was when i had surgery on them), and had a reaction. was then also diagnosed at 10 years old with central core disease by a muscle biopsy, which is related to mh, and thankfully through my multiple other surgeries ive never had a second reaction. did have an almost close call when i was 14 and went to the er to have my appendix removed, and the er surgeon refused to call up the anaesthesiologist so i could talk to them or contact them himself, because hed never heard of mh and thought i was making it up for attention. thankfully mom went to the nurses station to demand another surgeon and asked the nurse to also call the anaesthesiologist down, and i got to talk to both before i went into surgery. ive been reading all the research i have access to about mh, but i learned a lot of new information from this, so thank you so much for this video!!!

[@ianwilliams4480]

Father and Grandfather were trigged under general. Sister showed positive with genetic testing. I'm stage 4 Liver cancer with other health issues. Been under 3 times so far this year. Makes surgery e tra stressful. Thank you for this video.

[@ShermanGranados]

Awesome Video my friend!!! In Latin America Ryanodex it’s practically zero!

[@ThongNguyen-ih2hm]

Hope you match into the program of your choice, Max !!!!

[@irishpatti3152]

OR nurse since 1990. Only saw 1 case of MH. This was in a pediatric pt. Very scary. I was at a hospital not designed for pediatric emergencies ....

[@dennisharvey8179]

Iv been waiting to see this video thanks it really explains everything lol they didn't tell me much it the hospital about it other than I have mh always let the doctors know I have it and it's rare I guess I came really close to dieing from it I was in a coma for 2 weeks after and my kidneys were failing long story short I left the hospital 40 days later doing well

[@memyselfandi582]

very interesting

[@wythetrumpet6419]

I hope if I have to go under the knife, the individual putting me to sleep is as good as Max! 👍

[@Philfluffer]

Anesthesia and pathology are the best, your patients are either unconscious or you never even need to meet them or deal with them at all!

[@ricyha]

hey Max, this will probably never reach you, but just wanted to say thank you. I've been struggling with obsessive laziness and an unhealthy proclivity towards video games. Instead of watching streamers, video game content, or random tech channels for entertainment breaks, I've switched over to your content. Your videos have been so intriguing to me (as a pre-nursing student and pharmacy tech-in-training). It's strange how a person I will never meet has inspired me so much. If the next couple years turn out well, I aspire to be a surgical or circulating nurse. One day.

[@babyangel5497]

Yes yes I had this subject in school 🤩🤩🤩

[@Rawr8987]

had a MH episode not too long ago on our floor. i work in pharmacy and our pharmacist was speechless. she ran straight to the OR just to help. i was clutching our kit hoping the guy was ok. they started pushing dantrolene but he did end up ok thankfully

[@fibonaccisequence4225]

This actually makes me feel better about getting surgery done.

[@jonesnori]

Yes! I also follow an air disasters channel (Mentour Pilot) with excellent and thorough explanations, and many viewers comment that his videos reduce their fear of flying. Medicine and flying both improve over time by, among other things, learning from past experiences.

[@fibonaccisequence4225]

@@jonesnori I love Mentour Pilot! His channel is so interesting. I have an interest in learning to fly.

[@jonesnori]

@@fibonaccisequence4225 Expensive, isn't it? But what fun!

[@onepawatatime7925]

I love your videos, always so informative! I was pursing medicine at one point but the field burned me out. So now I just learn for fun. People always know I'm reading some new research article. So I love your videos because they are always so informative and even entertaining! I did have a question though. From my understand an anesthesiologist is supposed to be available in the PACU should an emergency arise? Correct? I was just curious because two weeks ago I had abdominal surgery and unfortunately has a severe dystonic reaction to the anesthesia in PACU. I was fully unaware but unable to control my body. I distinctly remember that despite the 12 people in the room neither my anesthesia attending or anesthesia resident was present. And I also remember more than one person asking where anesthesia was. My surgeon was there and ended up calling the stroke team to get a neurologist down to look at me and it all ended fine after some IV Benadryl but it was always my understanding that an emergency such as that would be an anesthesiologist responsibility. I was surprised neither attending or resident were present and was curious if my understanding was incorrect! Also I would love to see a video some day on anesthesia considerations for mitochondrial disease or inborn errors of metabolism. I know they have a unique set of needs. As well as autonomic neuropathy would be another great one! Thanks for all the great work you do making this videos, I will always keep watching!

[@unknownentity7964]

I have a rare mitochondrial disease, and have always had dystonic reactions to anesthesia. I've never been told the cause. Is it linked to mitochondrial diseases in some way? If so, that'd explain so much! I have autonomic failure as a result. I've never met anyone who has had similar!

[@onepawatatime7925]

@@unknownentity7964 Wow, someone else! My suspected diagnosis is mitochondrial disease and I also have autonomic neuropathy. I don't know about a defientive link to mitochondrial disease but since that incident I have spoken with many people with Mito who have had similar experiences. So I would say likely yes! It's so nice to meet someone else like me!

[@evanstedman7405]

Methoxyflurane (sold under the trade names Penthrane or Pethrox) also triggers this. Which is a problem for those in the prehospital care setting as it is incredibly good for rapid relief of severe pain.

[@The_New_Abnormal_World_Order]

That's really scary. I saw a TV series from Australia where the lifeguards were treating all kinds of things with methoxyflurane, it sounds like it's hard enough to treat MH in an operating theatre, let alone on a beach where the paramedics aren't always present yet.

[@evanstedman7405]

@@The_New_Abnormal_World_Order the thing is malignant hyperthermia is a really rare thing to come across. And you don't know you are prone to it until you are affected by it. But Penthrane is so good at what it does it is still a valuable inclusion in emergency response kits. The thing you have to understand is that there are rules around the use of it which means anyone who has the potential to find themselves in a situation where it needs to be used needs to be appropriately trained in its use and follow the standard treatment protocols which limits the number of times and circumstances where it can be used. It is not something that is available to the untrained because it is a highly regulated compound.

[@XSemperIdem5]

Is that what paramedics are using in the UK when they offer the person "gas"? I've watched some of those shows that have a camera crew ride along in ambulances and I saw that so often but never bothered to look into it back then.

[@evanstedman7405]

@@XSemperIdem5 nope. The gas you refer to is likely called Entonox which is a half and half mix of nitrous oxide and oxygen. Methoxyflurane is also colloquially known as "The Green Whistle" because when it is administered it is contained in a green container which the patient holds themselves and breathes through when they need pain relief.

[@XSemperIdem5]

@@evanstedman7405 thanks for the info. Since we don't use that here in the U.S. I'm not familiar with it.

[@kostasva843]

@Max Feinstein how do you differentiate MH and neuroleptic malignant syndrome in the OR? What happens if you give dantrolene to a patient and he doesnt have MH? What are the adverse effects of dantrolene? Thank you!

[@cade8986]

This happened once as we were putting a kid under for an MRI. We were all shocked but pretty excited after having seen it. Kid was fine.

[@maryann9400]

One of the most important things is identification of familial tendencies towards developing MH. It is because of this that hospitals have stressed questionnaires of anyone who is having surgery. ORs and ICUs (and even EDs) have made it a point to conduct annual competency testing of the recognition and treatment of MH. It’s also important to know that MH can also develop in some cases of psych drugs usage. Some cases have been implicated in rapid sequence intubation (RSI) with succinylcholine.

[@MrMaverick3098]

May I ask where the info graphics at 3:35 are coming from? They seem very interesting

[@CoryFinn2011]

Spectacular explanation! I am a big fan of your channel but NOT of surgery! Thank God for Valium and staff with zebra surgery caps!

[@k1mgy]

A dizzying array of treatment meds, on the spot diagnosis, potential interactions with the surgical process and patient issues creates a huge spin and I imagine massive stress upon the Anesthetist. Would be interested if you can discuss briefly this aspect of your work.